Tests to detect HIV in infants conducted at health facilities where they received care led to a significant increase in the percentage of infants with the virus given access to life-saving treatment, compared to tests analyzed in central laboratories, according to a report in Clinical Infectious Diseases.
The report notes that the findings have critical implications toward reducing the impacts of HIV on children, who remain among the last to have access to antiretroviral treatment, and the most vulnerable to effects of the virus without treatment.
While acceleration of treatment access for pregnant women living with HIV has helped drop numbers of children born with the virus, or becoming infected with the virus in infancy, by nearly three-quarters in the last decade and a half, the odds remained poor for the approximately 1.8 million children living with the virus in 2015, the authors of the report, led by Reuben Mwenda of Malawi’s Ministry of Health, write. Untreated, approximately 35 percent of children with HIV die before they turn a year old, and 52 percent die before they turn two. Initiation of antiretroviral treatment greatly improves these odds, but with the majority of children living with the virus going undiagnosed, less than 45 percent received antiretroviral treatment in 2015, the report says.
At least in part this is because diagnosing HIV in children exposed to the virus is complicated by the presence of antibodies from their mothers, whether they are actually infected or not — ruling out the rapid tests that return immediate results in a wide range of settings. Instead, until recently, blood samples from infants had to be sent to laboratories with equipment and personnel to conduct tests that determine the presence of the virus. In resource-limited environments that added up to both distance and time — with a lag between taking a sample and returning results that could add up to months, during which large numbers of infants can become ill as result of their untreated virus, or otherwise lost to follow-up care.
With the development of tests that could be conducted at the infants’ point of care, the World Health Organization pre-qualified two of them, and Malawi’s Ministry of Health tried them at seven clinics where staff were trained in their use.
Comparing outcomes for infants tested between January and August of 2015, before the point of care tests were adopted, and infants tested on site between September 2015 to March 2016, researchers saw a dramatic drop in the median number of days between when a sample was collected from an infant, and when the infant’s parents received results — from 56 days to zero. Two times more children diagnosed at their point of care began antiretroviral treatment than those whose tests were conducted at laboratories.
The results are in line with those of other studies, indicating that point-of-care testing can play a critical role in reaching goals for children, in line with global goals to control HIV as a global health threat, by ensuring that at least 90 percent of those living with the virus are diagnosed, at least 90 percent of them are accessing antiretrovial treatment, and that the treatment is accessible and consistent enough to control the virus in at least 90 percent of them.